Department of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599, USA.
Am J Rhinol Allergy. 2011 May-Jun;25(3):141-4. doi: 10.2500/ajra.2011.25.3593.
One criticism of current video systems for endoscopic surgery is that two-dimensional (2D) images lack depth perception and may impair surgical dissection. To objectively measure the efficacy of 3D endoscopy, we designed a training model with specific tasks to show potential differences between 2D and 3D endoscopy. Its clinical value was then evaluated during endoscopic sinus and skull base surgical cases.
Fifteen subjects were grouped according to endoscopic experience: novices and nonnovices. A training model was constructed to include five tasks: incision manipulation; ring transfer; nerve hook; distance estimation, visual only; and distance estimation, visual and tactile. Each participant was assessed with both a standard 2D endoscope and a 3D endoscope. The clinical value of a 3D endoscope (Visionsense, Ltd., Petach Tikva, Israel) was then examined in four endoscopic sinus cases and four skull base cases.
Of the subjects, six (40%) were novices. Overall, the errors committed during any one task were not significantly different between systems. Novices trended toward more success during the nerve hook task using the 3D system. With size cueing versus visualization alone, distance estimation was significantly more accurate. Novices tended to prefer the 3D system and experienced surgeons disliked the initial learning curve. Advantages were particularly noticed during skull base surgery; subjectively improved depth perception was beneficial during vascular dissection.
Three-dimensional endoscopy may improve depth perception and performance for novices. The 3D endoscope is a safe and feasible tool for endoscopic sinus and skull base surgery; it is promising for improving microneurosurgical dissection precision transnasally.
目前内镜手术的视频系统存在一个缺陷，即二维（2D）图像缺乏深度感知，可能会影响手术解剖。为了客观地衡量 3D 内镜的效果，我们设计了一个具有特定任务的训练模型，以展示 2D 和 3D 内镜之间的潜在差异。然后，我们在鼻窦和颅底手术病例中评估了其临床价值。
根据内镜经验将 15 名受试者分为新手和非新手两组。构建了一个训练模型，包括 5 项任务：切口操作、环转移、神经钩、仅视觉距离估计和视觉和触觉距离估计。每位参与者都使用标准的 2D 内窥镜和 3D 内窥镜进行评估。然后，在 4 例鼻窦手术和 4 例颅底手术中检查了 3D 内窥镜（以色列佩塔提克瓦的 Visionsense 有限公司）的临床价值。
在受试者中，有 6 名（40%）是新手。总体而言，两个系统在任何一项任务中犯的错误没有明显差异。在神经钩任务中，新手使用 3D 系统的成功率更高。与仅可视化相比，带有尺寸提示的距离估计更准确。新手倾向于更喜欢 3D 系统，而经验丰富的外科医生不喜欢最初的学习曲线。在颅底手术中尤其注意到优势，血管解剖时深度感知的改善有助于提高手术效果。
3D 内镜可能会提高新手的深度感知和手术表现。3D 内窥镜是鼻窦和颅底手术的一种安全且可行的工具；它有望通过经鼻微创手术提高神经外科手术的精细解剖精度。
